Methods for Measuring the Acute-1-6

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53例重症急性胰腺炎患者腹内压监测的临床应用

53例重症急性胰腺炎患者腹内压监测的临床应用

China &Foreign Medical Treatment中外医疗重症急性胰腺炎(Severe Acute Pancreatitis,SAP)是一种自身消化性疾病,病情复杂凶险,发展迅速,短时间内可并发多器官功能损害,病死率高20%~30%[1],SAP 腹内高压已引起越来越多临床医生的关注,其直接影响着重症急性胰腺炎本身的治疗和预后,并且已经作为判定重症急性胰腺炎预后的重要指标之一。

SAP 患者常导致腹内高压而并发腹腔间室综合征(Abdominal compartment syndrome ACS),引起多器官功能衰竭(multiple organdysfunction syndrome MODS)。

因此加强腹腔压力(Intra-abdomi⁃nal pressure,IAP)监测及认识是非常重要的[2]。

现对2011年9月—2012年4月该院ICU 收治的53例重症急性胰腺炎患者进行腹腔压力监测,现报道如下。

1资料与方法1.1一般资料该组患者53例,其中男35例、女18例;年龄33~68岁,平均(45.3±7.5)岁。

所有患者均符合重症急性胰腺炎的诊断标准,重症急性胰腺炎的APACHE—II 评分≥8分[3]。

重症急性胰腺炎的诱因分别为:胆道疾病34例、暴饮暴食15例、酗洒2例、无明显诱因2例。

1.2测压方法该组患者通过测定膀胱内压力(UBP)代替腹内压。

对53例重症急性胰腺炎患者入ICU 时即给予留置双腔导尿管,Foley14~16F,气囊充气30mL 后妥善固定。

导尿管接口连接三通连接管,其一端接引流袋,一端连接有创测压装置,换能器装置采用美代250,连接飞利浦M60或M70多功能监护仪。

测定方法:排空膀胱,夹闭尿液引流袋,将导尿管与有创测压装置连接,患者取平卧位,将换能器归零,以患者耻骨联合水平为零点,将50mL 生理盐水经Foley 导尿管注入膀胱后,导尿管与换能器相通,监护仪上直接读取数据即为腹内压,单位mmHg。

急性冠脉综合征患者白介素-6与全球急性冠状动脉事件注册评分的相关性

急性冠脉综合征患者白介素-6与全球急性冠状动脉事件注册评分的相关性

急性冠脉综合征患者白介素-6与全球急性冠状动脉事件注册评分的相关性李晶玮;王鸿;徐秀英;杜凤和;田俊萍【期刊名称】《中国医药导报》【年(卷),期】2017(014)008【摘要】Objective To investigate the relationship between serum interleukin-6 (IL-6) level and Global Registry of Acute Coronary Events (Grace) score in patients with acute coronary syndrome (ACS).Methods The 104 ACS patients who came from Coronary Care Unit in Beijing Tiantan Hospital,Capital Medical University from June 2015 to August 2016 were enrolled in the present study.Serum IL-6 was measured.All the patients were divided into three groups according to Grace risk score:low risk group (≤ 108 score),moderate risk group (109-140 score) and high risk group (>140 score).According to the IL-6 level,patients were stratified into 4 groups by quartile (from the lowest to the highest,Q1-Q4).The relationship between serum IL-6 1evel and Grace risk scores in ACS patients was analyzed.Results The IL-6 level was significantly higher in high risk group than that in low risk group (P < 0.01) and moderate risk group (P < 0.01).As compared with Q1-Q3 group,the Grace risk score and percentage of high risk patients were higher in the Q4 group (P <0.05).Correlation analysis found that IL-6 was positively associated with Grace risk score (r=0.269,P < 0.05).Conclusion The IL-6 is positivelyassociated with Grace risk score in ACS patients,and IL-6 maybe an important biomarker for prognosis prediction of ACS patients.%目的探讨急性冠脉综合征(ACS)患者白介素-6(IL-6)与全球急性冠状动脉事件注册(Grace)评分之间的关系.方法入选2015年6月~2016年8月首都医科大学附属北京天坛医院心脏重症监护病房(CCU)首次诊断的ACS患者104例,根据Grace评分,将患者分为低危组(Grace评分≤108分)、中危组(Grace评分109~140分)和高危组(Grace评分>140分).检测IL-6,将IL-6水平从低到高按四分位数分成Q1~Q4组.分析IL-6与Grace评分的相关性.结果 Grace评分高危组患者IL-6高于中危组(P <0.01)和低危组(P< 0.01).Q4组Grace分值及高危百分比都高于Q4以下组(P<0.05).相关分析显示,IL-6与Grace评分呈正相关(r=0.269,P<0.05).结论 ACS患者IL-6与Grace评分明显正相关,IL-6可能成为ACS患者预后判断的重要血清标志物.【总页数】4页(P76-79)【作者】李晶玮;王鸿;徐秀英;杜凤和;田俊萍【作者单位】首都医科大学附属北京天坛医院心内科,北京100050;航天中心医院内分泌科,北京100049;首都医科大学附属北京天坛医院心内科,北京100050;首都医科大学附属北京天坛医院心内科,北京100050;首都医科大学附属北京天坛医院心内科,北京100050【正文语种】中文【中图分类】R541.4【相关文献】1.急性冠脉综合征患者B型利钠肽与全球急性冠状动脉事件注册评分的相关性 [J], 李晶玮;王鸿;杜凤和;徐秀英;田俊萍2.全球急性冠状动脉事件注册评分与非ST段抬高型急性冠脉综合征患者急诊危重度指数的相关性分析 [J], 陈天喜;沈红五;崔秋霞;顾玉慧;姜丽娟;缪爱凤3.25羟维生素D与急性冠脉综合征患者全球急性冠状动脉事件注册评分的相关性[J], 李奔;张波涛;胡光欣;李银萍;齐喜娟;李海;刘志军4.中性粒细胞与淋巴细胞比值联合全球急性冠状动脉事件注册研究评分与急性冠脉综合征患者预后的相关性分析 [J], 徐晓婷;张强;杨丽红;郑红梅;孙彩红;方士杰;刘英;刘方方;许慧艳5.急性冠脉综合征患者血清钙与全球急性冠状动脉事件注册评分的相关性 [J], 王荣荣;王琳琳;王鸿;田俊萍因版权原因,仅展示原文概要,查看原文内容请购买。

假肢与矫形器专业词汇英语

假肢与矫形器专业词汇英语

假肢与矫形器专业词汇(英语)abdomen anatomical retainer of the intestinesabdominal related to the abdomenabduct to move (a limb) away from the midline of the bodyabducted gait walking with the legs spread away from the midlinemuscleabductor abductingablatio mammae, mastectomy surgical removal of female breastabove elbow (A.E.) prosthesis prosthesis for transhumeral amputationabove the knee (A.K.) prosthesis prosthesis for transfemoral amputation - (AK)abutment counter piece, counter flare, neckacceleration getting continuously fasteracceleration phase sub-phase in the swing phase of gaitinpelvis, receiving the hip jointsocketacetabulum concaveacetone chemical thinner for laquers and paintsAchilles tendon tendon at distal end of calf muscleacrylic resin thermoplastic resin on acrylic basisacute rapid onset or short duration of a conditionadapter device coupling two different endsadduct to move (a limb) toward the midline of the bodyadductor adducting muscleadductor roll medial-proximally located roll oft soft tissue (TF-prosthetics) adhesion contact socket contact socket, type of suction socketadiposity being too large in abdominal and other circumferences, fat ADL's aids for daily livingadolescent juvenile - phase between childhood and adulthoodadultadolescent youngadult “grown up” - beyond adolescenceaetiology reason or factor causing a diseaseAFO ankle-foot-orthosisagonist muscle being active and result-oriented (opposite:antagaonist) aids for daily living (ADL) tools and devices etc.- modified for the disabledair splint orthoses containing an air chamber to customize fitAK (prosthesis) prosthesis after transfemoral amputationAK-socket above knee (transfemoral) socketalignment assembling O&P components referring to a reference system allergy reaction of the immune system against “foreign” matteralloy a mix of metals, changing the specific characteristics aluminum a light metalambulate / ambulation reciprocal walkingambulator a walking frame, supporting a patient's ambulation amputation surgical removal of a body partamputation surgery surgical act of removing a body segment (extremity) analgesia absence of, or insensitivity to pain sensationanalyse, analysis detailed research on components of a wholeanamnesis background of a diseaseanatomical landmarks (bony) prominences, points of importance in O&Panatomy descriptive or functional explanation of the body properties angularity in the shape of an angleangulus sub-pubicus angle of the pubic ramus, important in IC-socketsjointankle tibio-tarsalankle block connector between prosthetic foot and shinankle joint (talus joint) joint connecting foot and shankankle-foot orthosis (AFO) orthosis with functional impact on ankle and footankylosing to unite or stiffen by ankylosisankylosis immobility, posttraumatic fusion of a jointantagonist muscle opposing agonist action, often controllinganterior in front of, the foremostanteversion to bring (a limb) forward, opposite of retroversion anthropometry taking measurements of the human bodyanti… againstanvil block of iron, surface used in forging metalA-P or a-p antero-posterior, from front to backapex top or summit, the highest point, the peakappliance an instrument, O&P: a prosthesis or orthosis, technical aid application making work or connecting to…learning a professionapprentice somebodyapprentice student learning a profession or craft in a structured approach apprentice student learning a profession or craft in a structured approach apprenticeship (course) training course for vocational educationappropriate best (compromise-) solution for a given problem Appropriate Technology technology appropriate (e.g. for the Third World)arch support shell shell-like custom molded medical shoe insertarteries blood vessels transporting oxygenated blood to the periphery arthritis acute or chronic joint inflammationarthrodesis blocking a joint through surgical procedurearthroplasty reconstruction of a joint through surgical procedure arthrosis, osteoarthritis joint disease - degenerating cartilage and joint surfaceGelenkarticulation Articulatio,aseptic not caused by bacterial infectionASIS / A.S.I.S anterior superior iliac spineassessment evaluation, obtaining information (about a condition) athetosis condition of slow withering movementsathletic arch support custom molded medical shoe insert for the athleteatrophy shrinkage, wastage of biological tissueautonomic nervous system independent nerve tissue, not under voluntary controlaxial rotator joint for socket rotation around the vertical axisback posterior component of the trunkbalance condition of keeping the body stabilized in a desired positionball bearing bearing cage containing rollers, making/keeping axes rotatable ball joint (universal joint) tri-axial jointband, strap, cuff suspension aid (small corset)bandages elastic wrapping, light brace, adhesive wrapping etc.bandaging act of applying bandages, tapingbands m-l connection between orthotic side bars (calf band etc.)bars, side-bars uprights, vertical struts in an orthosisbearing, ball bearing bearing cage containing rollers, making/keeping axes rotatable bed sore pressure/shear related skin trauma of bed-bound individuals below elbow amputation (BE-) forearmamputation (below the elbow joint, transradial, transulnar) below elbow, lower arm arm below the elbow jointbelt suspension component, also light abdominal bandagebench workstation,worktablebench alignment static alignment of prosthetic/orthotic componentsbending providing a shape or contour to sidebars, bands etc.bending iron set of two contouring tools for metal bar bendingbending moment the force or torque bending an objectbending, contouring providing a shape or contour to sidebars, bands etc.BE-prosthesis prosthesis after amputation below the elbow jointbevel to brake an edgebig toe halluxbilateral twosided, double..., relating to “both sides”bio-engineering science of engineering related to living structuresbio-feedback internal autoresponse to a biological eventbiological age the "natural age" - dependent on how a person presentsbiology science related to living structuresbio-mechanics science combining biology and mechanicsbipivotal joint joint with two axesBi-scapular abduction bringing both shoulders forward simultaneously (prosthetic control motion)BK below the kneeBK-prosthesis prosthesis after amputation below the kneeBK-socket below the knee socketblister forming vacuum molding plastic sheet material in a frameblock heels wide basis heelsbody the total appearance of a biological beingbody jacket US-American term for symmetrical spinal orthosesbody powered operated by human power (as opposed to outside energy) bolts machine screw and similarbonding agent connective glue, cement etc.bone single part of the skeletal systembone loss syndrome reduction of bony massbone spur a protrusion of bone or fragment of bonebonification, calcification change into bony tissuebony bridge surgical bony fusion between e.g. tibia and fibulabony landmark anatomically protruding bony surfaces (as the fibula head) bony lock (ischial containment) m-l tight locking design in ischial containment sockets bordering providing a smooth trim line or brimbordering, trimming providing a well-rounded trim line or smooth brimBoston Brace spinal orthosis developed in Boston, USA (scoliosis, kyphosis treatment)bouncy mechanism flexion device for limited flexion in prosthetic kneesbow leg genu varum, o-shaped legs, enlarged distance between knees brace, splint, caliper supportive device, old-fashioned for “orthosis”brain, cerebrum main switch board of the central nervous systembrazing heat supported metal solderingbrazing tool, soldering iron tool for heat supported metal solderingbrim proximal socket area, casting tool / templatebrooch / hook hooks holding a lace, closure of shoes etc.buffing creating a shiny surface finishbuild-up (of a material) location of added plaster in modifications of plaster castsburn heat related injurybursa anatomic padding cavity containing liquidby-law (USA: bill) lawCAD CAM Computer Aided Design, Computer Aided Manufacture cadence rhythm of walkingcalcaneus heelbonecalculation doing mathematical operationscalf band m-l connection between side bars (KAFO)calf corset enclosure of calf and shin (in an orthosis)calf muscle, triceps surae plantar flexor of the foot, muscle in the lower legcaliper measuring tool, precision instrumentcaliper, brace, splint old fashioned term for joint stabilizing lower limb orthoses Canadian Hip Disarticulation Pr. external shell prosthesis for hip disarticulationscane walkingstickcap band finishing element of trim lines, brims of corsetscarbon fiber structural reinforcement in plastic compositescardanic two axes, aligned in 90 degrees toward each othercardio-vascular related to heart and blood circulationcarve shaping by taking material off (chipping off, sanding off)cast positive (plaster or similar) moldcast modification functional changing of the shape of a castcast removal removal of plaster bandage from a poured plaster castcast taking act of taking a plaster- or similar impressioncasters freely moving front wheels at a wheel chaircasting and measurement taking getting 3-dimensional body impressions and measurements casting procedures technique of getting 3-dimensional body impressions caudal direction, toward distal end of the vertebral column (tail)c-clamp clamping tool (woodwork)CDH congenital dislocation of the hipcell (biological and technical) smallest living unit; hollow technical unitcellular made up from cellscelluloid one of the first plastic materials availablecement, glue bonding agentcenter of gravity (COG) mathematic-physical mass concentration in one point center of mass calculated concentration of mass (in bio-mechanics) center of mass (COM) mathematic-physical mass concentration in one point centrode graph for the path of the instantaneous centers of rotation cerebral related to the cerebrum, braincerebral palsy loss of neural muscle control by congenital brain damage cerebral paresis dysfunction of muscle tissue related to cerebral trauma cerebro vascular accident vascular bloodclotting in a part of the brainbraincerebrum thecerebrum / cerebral brain / related to the braincervical related to the neckcervical collar (cervical brace) orthosis for the neck (after whiplash syndrome)cervical spine most proximal segment of the spinal columnchairback brace posterior semi-shell trunk orthosischamfer to thin out the edges of a materialCharcot joint rapid progressive degeneration of a joint (foot)check-, or diagnostic socket transparent or translucent socket for diagnosis of fit chiropedist (Canada) medical doctor specialized in foot careChopart amputation tarsal (partial) foot amputation at the Chopart joint line Chopart joint tarsal joint line of several bones in the footchronic long term (disease; opposite of acute)circumduction semi-circular (mowing) forward swing of a leg circumference the measurment around a physical bodyclam shell design longitudinally split socket or shellclosure mechanism used to closeclub foot, talipes varus pes equino varus, a congenital (or acquired) foot deformity CNC Computer Numeric Controlled design and manufacturing CO cervical orthosis, orthosis for neck immobilizationCO - CP - CPO Certified ... Orthotist..Prosthetist..Prosthetist/Orthotist coating surface cover (as plasticising metal surfaces)coccyx Anatomy: the “tailbone”coefficient of friction number determining forces between sliding surfacescollar cervical orthosis, orthosis for neck immobilization collateral ligaments ligaments bridging the side of jointscompatible fitting to each othercompliance measure of willingness to follow a therapeutic ordercomponents single parts of a whole, construction parts, pre-fab partscomposite reinforced plastic component, matrix and fillercompound result of a chemical binding processcompression panty hose orthotic garment to treat varicosisconcave inwardly shaped, hollow (opposite of convex)condyle massive rounded end of bone, basis for forming a joint surfacewithborncongenital beingconstant friction continuous application of a braking forcecontact cushion distal contact padding in prosthetic socketcontact measuring measuring while touching the object measuredcontact pad contact cushion (prosthetics)continuous passive motion (CPM) keeping a joint mobile through passive motion in motorized device contour (the) the outer perimeter of a bodycontour (to) creating a shape by forming, bendingcontour drawing draft of the outer perimeter of a bodycontracture condition of motion limitation in jointsconvex outwardly shaped, bulged (opposite of concave)cork bark of a tree, natural cellular leight weight materialcoronal plane frontal planecorrection, rectification modification (of shapes, designs etc.) in order to improvecorrosion deterioration of materials by chemical influence (as oxdation)corset therapeutic circular enclosement of body segmentscorset, fabric corset lumbar brace made from textile materialcountersinking taking the edge off a drilled hole, creating circular concavitycoupler a connective devicecoxitis/coxarthritis inflammation of the hip jointCPM, continuous passive motion keeping a joint mobile through passive motion in motorized device CPO Certified Prosthetist / Orthotistcraft & trade European (German) vocational structuring systemcranial relating to the headcrossline filing using a handheld file in a 90 degrees offset directioncruciates, cruciate ligaments crossed ligaments at the knee centerCRW Community based Rehabilitation Worker (WHO Geneva)CT, computer tomography a method to take X-rays in "slices"Orthosis CTLSO Cervico-Thoraco-Lumbo-SacralOrthosisCTO Cervico-Thoracocuff, band, strap suspension aid (small corset)cup, connection cup socket connector in prostheticscure (med.) medical therapeutic measurecure (techn.) to set, hardencushion, pad upholstering device, providing soft surfacecustom made made to measurements as a single unitdeceleration to become continuously slowerdeceleration phase sub-phase in the swing phase of human gaitdecree, directive, regulation text in the lawbooks or regulation with law-like characterdeficiency lack of necessary function or ability by physical impairmentdeflector plate a leaf spring design in prosthetic feet, energy return devicedeformity malformation of form, may be influencing functiondegeneration biological wear and tearDelrin a plastic material, used as a flexible, energy returning keeldensity foaming hard foam block on a socket as a connector to componentsdeposit (biological or pathological) storage mechanism, sedimentdermatitis skin disease, infection of the skinderotating orthosis (scoliosis) orthosis for derotation - one of the priciples of scoliosis treatment design construction, functional lay-out and planningdexterity, manual skill skill of creating by hand, craftsman skilldiabetes mellitus carbohydrate metabolism disorder (frequent amputation reason) diabetic gangrene death of tissue caused by diabetesdiagnosis searching and finding a cause and details of diseasediaphysis shaft of a long bonedimension seize as measureddimensional stability keeping the dimensionsdiplegia paralysis, affecting both sides of the bodydirect socket technique manufacture of a prosthetic socket directly on the amputee's limb directive information or order on how to …..directive, regulation, decree text in the lawbooks or regulation with law-like characterdisability handicap, functional loss of abilitydisabled person a person with a disability, handicapdisabled, handicapped handicapped, having a functional loss of ability"amputation"directly through a joint linedisarticulation thedisc, intervertebral disc intervertebral cartilaginous cushioning elementdislocation joint injury resulting in complete discontiuity of joint surfaces dislocation overstretching or rupture of ligaments, also in combination with fracture doff US-colloquial: do - off = take offdoffing a prosthesis taking off a prosthesiscontrollingdominant leading,don US-colloquial: do - on = put ondonning a prosthesis putting on a prosthesisdonning aid aid to don a prosthesis as pull sock, stockinette, silk tie etc.dorsal related to the dorsum = back, posteriorly locateddorsiflexion lifting the forefoot, correct would be “dorsal extension”, lift of footdraft first drawing of a new ideadrawer effect a-p instability of the knee caused by slack cruciatesdrill (to) to machine a holeDS(L)T Direct Socket (Lamination) TechniqueDUCHENNE's disease severe progressive form of muscular dystrophyDUCHENNE's sign trunk bends lateral toward stance leg during stance phaseDUPUYTREN’sche Kontraktur fibrosis, flexion contracture of fingers into palmstiffnessdurometer hardness,duroplastic resin synthetic resin, not thermoplastic after initial curingdystrophy pathologic loss of muscle massCommunityEC Europeanedema, oedema swelling, high concentration of fluids in the soft tissueelastic capable of recovering form and shape after deformation elastic anklet ankle foot orthosiselastic bandage, ACE-bandage stretchable, expandable bandageelastic knee sleeve knee supporting soft orthosis, tt-prosthetic suspensionelbow splint old-fashioned term for: elbow orthosiselectrical stimulation neuromuscular stimulation by electric impulses electromyography recording of electrical activity of a muscleembedding enclosing, encapsulating, (German: socket retainer function) embossing manual shaping of sheet metal by special hammerEMG recording of electrical activity of a muscleendo-skeletal pylon type prosthetic components covered by external cover energy consumption use of energy in physical activitiesenergy expenditure spending of energy in physical activitiesenergy return energy output, achieved by spring-like design in O&PorthosisEO elbowepicondylitis stress related inflammation of the elbow, (tennis)epiphysis dist./prox. End of a bone, zone of longitudinal growth equilibrium keeping of balanceequinovalgus combined drop foot and valgus deformityequinovarus combined drop foot and varus deformityeversion rotation of hand or foot around long axis of the limbeversion turning foot outward and up (opposite of inversion)EWHO elbow wrist hand orthosisexamination, assessment evaluation, obtaining information (about a condition)exo-skeletal prosthetics: external structural components (opposite: modular) extension straightening motion of a jointextension assist strap or other means assisting joint extensionextension moment force (torque) causing extension (straightening) of joints extension stop bumper or other means of extension limitationextensor muscle causing extensionexternal related to the outside (opposite: internal)external fixation outside orthotic fixation (of a fracture or a surgical result) extremity upper or lower extremities: arms or legsfabric corset textile orthosis for the abdomen or trunkfabrication the procedure of mechanically creating a devicefatality mortality, death ratefatigue (material) time-dependent alteration of typical material propertiesfatigue (muscles) time-dependent slow down of muscle actionFederal Trade Association German professional trade associationfeedback return of informationfelt material made up from compressed, interwoven hair or fiber female the woman species in a creature (opposite: male)femoral channel dorso-lateral convex channel in a prosthetic socketfemoral condyles the distal ends (close to the knee joint) of the femurfemur the thigh boneFES functional electrical stimulationfibre glass (fiber glass) glass reinforcement component in compositesfibula calfbone, the lesser of two bones in the calffibular head the proximal thicker portion of the fibulafit compatibility between patient and device in function/comfortflab abundance of soft tissueflaccid paralysis, paresis non-spastic paralysis, loss of voluntary muscle innervationflare even anatomical surface (as the tibial flare)flat evenflat foot foot deformity, loss of medial-longitudinal arch heightflatfoot, talipes planus foot deformity, loss of any medial-longitudinal arch heightflexion joint motion, buckling or bending a jointflexion assist device assisting (joint) flexionflexion moment force (torque) causing flexionflexor muscle creating a flexion motionfloor reaction orthosis orthosis utilizing floor reaction forces for patient stabilizationFO (either) finger orthosis (or) foot orthosisfoam a cellular resin (polyurethane foam hard or soft)foaming act of manual creation of a prosthetic foam connectorchildfoetus unbornfollow-up continuous control and maintenance, aftertreatmentfoot cradel anatomically adapted plantar foot supportfoot deformity misalignment (functional misshape) of the footfoot flat stance phase: sole of the foot getting in complete ground contact foot slap stance phase: uncontrolled quick foot flat motionforce cause or reason for acceleration, deceleration, movementforging non-chipping iron shaping process under the influence of heat fracture traumatic breaking of a boneframe the outer supportive, stiffening elementframe socket the outer supportive, stiff element as a retainer for a flexible socket freehand drawing, draft manual first draft or drawingcounter-acting sliding movement, "rubbing"friction forcefrontal plane, coronal plane reference plane as seen from the frontfulcrum center of a single axis joint, center of rotationfully synthetical man-made (material)functional component i.e. joints etc. (as opposed to structural components)functional level degree of function a disabled patient still achievesfunctional needs component need to satisfy specific needsfundamental of basic importanceambulationgait walking,gait analysis research of gait patterns and time-related specificsgait deviation pathological changes in normal walking patternsgait pattern physiological or pathological walking characteristicsgait trainer somebody teaching how to walkgait training lessons in learning how to walkgalvanization surface protection of metalsgangrene local death of soft tissue due to lack of blood supply gastrocnemii, “gastrocs” double-headed calf musclegauge measuring instrument (measures width / thickness)gear train joint joint components, forcing each other trough toggled connection gel man-made or natural material, consistency similar to gelantine genu kneegenu recurvatum hyper-extended knee joint (frequently seen in poliomyelitis) genu valgum/knock knee knock knees, knees frequently touching each other medially genu varum/bowleg bow legs, knee distance too large (opposite of genu valgum) geometric locking locking systematic of polycentric knee jointsgeometrical stance control locking systematic for the provision of stance stabilitygeriatric elderly, old, aged,glue, cement bonding agentgoniometer instrument (tool) for measuring anglesgrease fat, as lubricant or tissuegrid particle size indication in abrassive materialsgrind surface modification by abrasion, sanding etc.ground reaction force force directed from the ground toward the body Haemo.., haema... related to the bloodhallux, halluces big toeHalo brace cranial/cervical orthoses, ring fixed at proximal cranium hamstrings popliteal tendons, insertion of flexor muscleshand splint old fashioned for hand orthosishard and soft foaming technique of using hard and soft PU-foams in combinationhd extra sturdy version of…..disarticulationHD hipHDPE HighPolyethyleneDensityHD-socket pelvic socket of the hip disarticulation prosthesisheavy metals a specific group of metals (heavy in weight)heel clamp prosthesis a partial foot prosthesis, suspension by a posterior "clamp" heel cup foot orthosis, Berkely cupheel off / heel rise moment in stance phase when the heel risesheel spur bony protrusion at the distal-medial aspect of the calcaneus heel strike moment in stance phase when the heel touches the ground heel wedge heel bumper in foot or length compensation, absorbs shockHelfet’s heel cup foot orthosis, similar Berkely cupremoving the distal half of the bodysurgery,hemicorporectomy amputationhemipelvectomy amputation surgery removing one half of the pelvis hemipelvectomy-prosthesis artificial leg after hemipelvectomyhemiplegia paralysis of one half side of the bodyheredetary congenital by transmission from parent to offspringhernia subcutaneous protrusion of intestinshindfoot posterior 1/3 of the foot (heel and tarsus)hinge simple joint, single axiship dysplasia pathological development of hip socket leading to dislocation hip hiking exaggerated movement (lifting) of the hip joint in gaithip joint, articulatio coxae proximal joint of the leg, leg-pelvis jointhip positioning orthoses a brace controlling functional alignment of the hip jointhip socket concave component of the hip jointhip spica cast applied to pelvis and legHKAFO Hip-Knee-Ankle-Foot-OrthosisHO (either) Hand Orthosis (or) Hip Orthosis (!!)hobby-handicraft hobbyists work also meaning: non-professional resulthook and eyelet closure closure of textile fabric corsetshook and pile closure Closure material with interlocking surfaces (e.g. Velcro)hook and pile, Velcro self-adhesive strap materialhorizontal plane reference plane as seen from the tophosiery, medical hosiery medical compression hosiery (phlebology)humerus bone in the upper armhybrid something having properties of at least two different resources hydraulic joint control cylinder/piston device controlling prosthetic joint motion hyper… more of somethinghyperextension over-stretching (of a joint)hyperextension orthosis a spinal brace serving for reclination of the thoracic spinegrowthhyperplasia increasedhyper-reflexia pathologically exaggerated reflexeshypertonia elevated blood pressurehypertonicity increased muscle tone or muscle tensionhypertrophy growth of tissue by enlargement of cellshypo… less of somethinghypoplasia biological structure significantly diminished in sizehypotonia low blood pressurehypotonicity loss of muscle tone (or tension)ContainmentIC IschialICRC International Committee of the Red CrossICRC Ischial and ramus containmentIC-socket ischial containment socketidiopathic scoliosis adolescent scoliosis without a known causeilium, os ilium the medial or lateral "wing-shaped" bone in the pelvis。

IL-6、CRP和血清过敏原检测对急性荨麻疹的临床价值

IL-6、CRP和血清过敏原检测对急性荨麻疹的临床价值

基金项目:浦东新区科技发展基金民生科研(医疗卫生)项目(PKJ2018-Y22)作者简介:王科惠,女,1994年生,技士,主要从事临床检验研究。

通信作者:黄 韵,联系电话:。

IL-6、CRP 和血清过敏原检测对急性荨麻疹的临床价值王科惠, 黄 韵, 张正银, 王亚婷, 薛玉芹, 蔡苏芳, 樊 超, 金 英, 郑怡菁, 常金凤(上海市浦东新区浦南医院,上海 200126)摘要:目的 探讨血清过敏原检测、血清总免疫球蛋白E (IgE )抗体、过敏原特异性(sIgE )抗体、白细胞介素(IL )-6、C 反应蛋白(CRP )水平对于急性荨麻疹的临床价值。

方法 选取2018年6月—2019年12月上海市浦东新区浦南医院75例荨麻疹患者作为研究组,另选取同期75名健康体检者作为对照组,比较2组血清总IgE 抗体、sIgE 抗体、CRP 、IL-6水平对于急性荨麻疹发作期的诊断价值。

结果 研究组血清总IgE 抗体阳性率高于对照组,差异有统计学意义(P <0.05);研究组血清sIgE 抗体阳性率高于总IgE 抗体,差异有统计学意义(P <0.05);研究组血清CRP 、IL-6水平高于对照组,差异有统计学意义(P <0.05);研究组血清IL-6水平与总IgE 抗体水平具有一定的相关性(r =0.595,P <0.05)。

结论 患者血清过敏原检测及CRP 、IL-6水平对于急性荨麻疹筛查和诊断均具有一定的临床价值。

关键词:急性荨麻疹;过敏原;血清总免疫球蛋白E 抗体;过敏原特异性抗体;C 反应蛋白;白细胞介素-6Clinical diagnostic value of serum allergen ,IL-6 and CRP levels in patients with acute urticaria WANG Kehui ,HUANG Yun ,ZHANG Zhengyin ,WANG Yating ,XUE Yuqin ,CAI Sufang ,FAN Chao ,JIN Ying ,ZHENG Yijing ,CHANG Jinfeng.(Punan Hospital ,Pudong New Area ,Shanghai 200126,China )Abstract :Objective To investigate the diagnostic value of serum total immunoglobulin E (IgE ) antibody ,allergen specific immunoglobulin E (sIgE ) antibody ,interleukin (IL )-6 and C-reactive protein (CRP ) levels in patients with acute urticaria. Methods From June 2018 to December 2019,75 patients with urticarial treated in our hospital were selected as study group ,and 75 healthy persons were selected as control group. The diagnostic value of total IgE antibody ,sIgE antibody ,CRP and IL-6 in acute urticarial were compared between the two groups. Results The positive rate of serum total IgE antibody in the study group was significantly higher than that in the control group (P <0.05). The positive rate of sIgE antibody was significantly higher than that of the total IgE antibody in the study group (P <0.05). The serum CRP and IL-6 levels of the study group were significantly higher than those of the control group (P <0.05). The level of serum IL-6 in the study group was correlated with the level of total IgE antibody (r =0.595,P <0.05). Conclusion The combined detection and comprehensive evaluation of serum total IgE ,sIgE ,CRP and IL-6 have clinical value for early screening and diagnosis of acute urticaria.Key words :Acute urticaria ;Allergen ;Total IgE antibody ;sIgE antibody ;C-reactive protein ;Interleukin-6文章编号:1673-8640(2021)03-0300-04 中图分类号:R446.1 文献标志码:A DOI :10.3969/j.issn.1673-8640.2021.03.014急性荨麻疹是一种常见的过敏性皮肤疾病,以大小不等的风团、瘙痒以及血管性水肿为主要症状。

研究论文大葱油注奏毒液对胃癌操鼠...

研究论文大葱油注奏毒液对胃癌操鼠...

中文摘要大葱油注射液对胃癌裸鼠移植瘤的抑瘤作用摘要目的:本实验为中国大葱防治胃癌系列研究的后续研究,前期实验中用大葱提取物作用于体外培养的人胃腺癌细胞株MGC.803,能有效抑制胃癌细胞增殖,低浓度有诱导细胞分化作用,高浓度则诱导凋亡;证实Ca2+和CAMP是胃癌细胞凋亡信号传导过程中的重要信息分子,大葱油可能是通过上调细胞内第二信使Ca2+和CAMP水平实现的。

本实验将大葱油制各成注射液,完成其对人胃腺癌细胞株MGC.803体外抗肿瘤敏感性检测后;观察该注射液对荷瘤裸鼠MGC.803皮下移植瘤的生长抑制作用及其毒性作用。

方法:确定大葱油注射液半数杀伤浓度(IC,。

):人胃腺癌细胞株MGC.803复苏后接种于含小牛血清的RMPll640培养液中,37℃,5%二氧化碳条件下培养。

取对数生长期细胞,采用MTT法,不同浓度的大葱油注射液(1001ag/ml、751ag/ml、50rtg/ml、251ag/ml、12.51ag/m1),作用于MGC.803细胞24小时、48小时、72小时后,测定细胞增殖抑制率,用POMS软件程序运算出半数杀伤浓度(ICso)。

大葱油注射液的制备:大葱油0.49加入20mg/ml的吐温一80溶液后,安瓿封存。

100℃流通蒸气灭菌30分钟,贮存在避光处。

大葱油注射液毒性试验:取6~7周龄,体重20~22中文摘要克的昆明种小鼠,每10只为一组,共两组。

第一组腹腔注射10mg/ml的大葱油注射液0.5ml,第二组腹腔注射0.25ml。

用药后观察一周,未见小鼠死亡,遂行最大耐受量实验。

取6~7周龄,体重20~22克的昆明种小鼠20只,给每只小鼠腹腔注射最大浓度(10mg/m1)和最大容积(1m1)的大葱油注射液,上、下午各一次,观察7天。

建立裸鼠移植瘤模型:选用对数生长期的MGC-803细胞,收集并调整细胞数,用无血清的培养液稀释细胞使细胞终浓度达到1×107个/ml。

美国内分泌学会临床实践指南成人垂体机能减退症激素补充治疗(第一部分)中英对照(全文)

美国内分泌学会临床实践指南成人垂体机能减退症激素补充治疗(第一部分)中英对照(全文)

美国内分泌学会临床实践指南:成人垂体机能减退症激素补充治疗(第一部分)中英对照(全文)美国内分泌学会临床实践指南成人垂体机能减退症激素补充治疗Maria Fleseriu,Ibrahim A. Hashim, Niki Karavitaki, Shlomo Melmed, M. Hassan Murad, Roberto Salvatori and Mary H. Samuels. J ClinEndocrinol Metab, 101(11), pp. 3888–3921(DOI: /10.1210/jc.2016-2118)根据循证医学方法,由美国内分泌学会、美国临床化学协会、垂体学会、欧洲内分泌学会专家讨论,本指南针对成人垂体机能减退症的严重问题,涉及成人垂体机能减退症的评估和治疗,包括合理的生化评估、激素补充过量、激素补充不足、妊娠期垂体机能减退症的治疗、垂体手术或其他手术时的处理。

CK要点:Essential Points该指南阐述了可能影响垂体功能减退症患者治疗的特殊情况,包括妊娠护理、垂体或其他手术的手术后治疗、联合抗癫痫药物时的治疗以及垂体卒中后的治疗。

指南的建议包括但不限于:需要检测游离甲状腺素和促甲状腺激素来评估是否存在中枢性甲状腺功能减退症,中枢性甲减的甲状腺由于TSH的不足导致甲状腺的分泌减少。

中枢性甲状腺功能减退症患者应接受左旋甲状腺素治疗,剂量足以将游离甲状腺素(FT4)水平提高至参考范围的中上水平。

应使用生长激素的刺激试验来诊断疑似生长激素缺乏症的患者。

已经证实有生长激素缺乏症且无禁忌症的患者应接受生长激素替代治疗。

绝经前妇女如存在中枢性性腺功能减退(低促性腺激素性性腺功能减退),这种情况下性腺不产生或只产生极少量的激素,如无禁忌,可以接受相关的激素治疗。

产生异常大量稀释尿液的患者应考虑到中枢性尿崩症,并应通过相关的额检验检查进行诊断,确诊的患者如无禁忌应进行相应的治疗对于糖皮质激素水平低的患者,氢化可的松可以每日单次或分次给药。

经口摄食功能评估量表与洼田饮水试验应用于急性脑卒中患者中的信效度研究

经口摄食功能评估量表与洼田饮水试验应用于急性脑卒中患者中的信效度研究

·318· E-mail:zgqkyx@·方法学研究·经口摄食功能评估量表与洼田饮水试验应用于急性脑卒中患者中的信效度研究朱亚芳1,张晓梅2,肖瑞2,洪婧2,李璇1,雷清梅1,周宏珍1*【摘要】 目的 评价经口摄食功能评估量表(FOIS)和洼田饮水试验应用于急性脑卒中患者中的信效度,为急性脑卒中患者的吞咽功能评估提供更为有效的评估工具。

方法 采用便利抽样法,选取2016年4—9月南方医科大学南方医院神经内科收治的急性脑卒中患者304例为研究对象。

采用FOIS、洼田饮水试验对其进行评估,记录其发病初期第1、2次评估结果及发病1、3个月评估结果。

结果 量表的评定者信度:发病初期第1次FOIS评估结果与发病初期第2次FOIS评估结果的Kappa值为0.862,r s=0.934,P值均<0.001;发病初期第1次洼田饮水试验评估结果与发病初期第2次洼田饮水试验评估结果的Kappa值为0.923,r s=0.976,P值均<0.001。

量表的效标效度:发病初期第1次FOIS评估结果与改良Barthel指数评分结果的χ2值为118.21,r s=0.397,Cramer's V=0.624,P<0.001;发病初期第1次FOIS评估结果与美国国立卫生研究院卒中量表(NIHSS)评分结果的χ2值为78.50,r s=-0.461,Cramer's V=0.508,P<0.001;发病初期第1次洼田饮水试验评估结果与改良Barthel指数评分结果的χ2值为123.93,r s=-0.574,Cramer's V=0.638,P<0.001;发病初期第1次洼田饮水试验评估结果与NIHSS评分结果的χ2值为75.56,r s=0.464,Cramer's V=0.499,P<0.001。

发病初期第1次FOIS评估结果与发病初期第1次洼田饮水试验评估结果的r s=-0.933,P<0.001。

急性中枢神经系统感染患儿IL-6和TNF-α的变化及临床意义

急性中枢神经系统感染患儿IL-6和TNF-α的变化及临床意义

急性中枢神经系统感染患儿IL-6和TNF-α的变化及临床意义目的:研究急性中枢神经系统感染患儿血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的变化及临床意义。

方法:采用ELISA法对53例初诊为中枢神经系统感染患儿,其中,化脓性脑膜炎(PM)22例,病毒性脑膜脑炎(VE)31例,进行了血清IL-6和TNF-α水平测定,并与60例正常儿童的测定值进行比较。

结果:PM组患儿血清中IL-6和TNF-α水平分别为(636±329)pg/ml和(485±261)pg/ml,明显高于VE组的(175±136)pg/ml和(63±52)pg/ml 和对照组的(12±8)pg/ml和(17±13)pg/ml(均P<0.001),VE组血清中IL-6和TNF-α水平亦明显高于对照组(P<0.01和P<0.05)。

结论:IL-6和TNF-α参与了急性中枢神经系统感染的病理生理过程,血清中IL-6和TNF-α的测定可能对急性中枢神经系统感染的诊断具有一定的意义。

[Abstract] Objective: To study the change and clinical significance of interleukin-6 (IL-6) and tumor necrosis factor-Alpha (TNF-α) in children patients with acute central nervous system infection. Methods: ELISA was employed to detect the level of IL-6 and TNF-α in 53 children patients preliminarily diagnosed as acute central nervous system infection, and 22 patients were purulent meningitis (PM), 31 patients were viral meningitis (VE) within them. Results: The levels of IL-6 and TNF-α in blood serum of PM group were (636±329) pg/ml and (485±261) pg/ml respectively, significantly higher than that in VE group [(175±136) pg/ml and (63±52) pg/ml respectively] and control group [(12±8) pg/ml and (17±13) pg/ml respectively] (average P<0.001). The levels of IL-6 and TNF-α in blood serum of VE group were also obviously higher than that in control group(P<0.01 and P<0.05). Conclusion: IL-6 and TNF-α participate in the pathology physiological process of acute central nervous system infection, the detection of the levels of IL-6 and TNF-α in blood serum probably plays a role in diagnosing acute central nervous system infection.[Key words] Meningitis; Serum; IL-6; Tumor necrosis factor急性中枢神经系统感染一直是危害儿童健康的常见感染性疾病,具有较高的病死率和后遗症发生率。

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Methods for Measuring the Acute Toxicity of Effluents and Receiving Waters to Freshwater and Marine OrganismsFifth EditionOctober 2002U.S. Environmental Protection Agency Office of Water (4303T)1200 Pennsylvania Avenue, NWWashington, DC 20460EPA-821-R-02-012DISCLAIMERThe Engineering and Analysis Division, of the Office of Science and Technology, has reviewed and approved this report for publication. Neither the United States Government nor any of its employees, contractors, or their employees make any warranty, expressed or implied, or assumes any legal liability or responsibility for any third party’s use of or the results of such use of any information, apparatus, product, or process discussed in this report, or represents that its use by such party would not infringe on privately owned rights.iiCONTENTS Pageiii Figures ....................................................................................vi Tables (vii)1.Introduction (1)2.Types of Tests (2)3.Health and Safety (5)General Precautions (5)Safety Equipment (5)General Laboratory and Field Operation (5)Disease Prevention (6)Safety Manuals (6)Waste Disposal (6)4.Quality Assurance (7)Introduction (7)Facilities, Equipment, and Test Chambers (7)Test Organisms (7)Laboratory Water Used for Culturing and Test Dilution Water (7)Effluent Sampling and Sample Handling (8)Test Conditions (8)Quality of Test Organisms (8)Food Quality (8)Acceptability of Acute Toxicity Test Results (9)Analytical Methods (9)Calibration and Standardization (9)Replication and Test Sensitivity (10)Variability in Toxicity Test Results (10)Demonstrating Acceptable Laboratory Performance (18)Documenting Ongoing Laboratory Performance (18)Reference Toxicants (21)Record Keeping (21)5.Facilities and Equipment (22)General Requirements (22)Cleaning Test Chambers and Laboratory Apparatus (23)Apparatus and Equipment for Culturing and Toxicity Tests (23)Reagents and Consumable Materials (24)Test Organisms (26)6.Test Organisms (27)Test Species (27)Sources of Test Organisms (28)Life Stage (29)Laboratory Culturing (29)Holding and Handling Test Organisms (29)Transportation to the Test Site (29)Test Organism Disposal (30)7.Dilution Water (31)Types of Dilution Water (31)Standard, Synthetic Dilution Water (31)CONTENTS (CONTINUED)Use of Receiving Water as Dilution Water (33)Use of Tap Water as Dilution Water (35)Dilution Water Holding (36)8.Effluent and Receiving Water Sampling and Sample Handling (37)Effluent Sampling (37)Effluent Sample Types (37)Effluent Sampling Recommendations (38)Receiving Water Sampling (39)Effluent and Receiving Water Sample Handling, Preservation, and Shipping (39)Sample Receiving (40)Persistence of Effluent Toxicity During Sample Shipment and Holding (40)9.Acute Toxicity Test Procedures (41)Preparation of Effluent and Receiving Water Samples for Toxicity Tests (41)Preliminary Toxicity Range-finding Tests (43)Multi-Concentration (Definitive) Effluent Toxicity Tests (43)Receiving Water Tests (43)Static Tests (44)Flow-Through Tests (45)Number of Test Organisms (45)Replicate Test Chambers (45)Loading of Test Organisms (46)Illumination (46)Feeding (46)Test Temperature (46)Stress (47)Dissolved Oxygen Concentration (47)Test Duration (50)Acceptability of Test Results (50)Summary of Test Conditions for the Principal Test Organisms (50)10.Test Data (67)Biological Data (67)Chemical and Physical Data (67)11.Acute Toxicity Data Analysis (71)Introduction (71)Determination of the LC50 from Definitive, Multi-Effluent-ConcentrationAcute Toxicity Tests (72)The Graphical Method (72)The Spearman-Karber Method (76)The Trimmed Spearman-Karber Method (78)The Probit Method (81)Determination of No-Observed-Adverse-Effect Concentration (NOAEC)from Multi-Concentration Tests, and Determination of Pass or Fail (Pass/Fail)for Single-Concentration (Paired) Tests (83)General Procedure (88)Single Concentration Test (95)Multi-Concentration Test (98)12.Report Preparation and Test Review (109)Report Preparation (109)Introduction (109)Plant Operations (109)ivCONTENTS (CONTINUED)Source of Effluent, Receiving Water, and Dilution Water (109)Test Conditions (110)Test Organisms (110)Quality Assurance (110)Results (110)Conclusions and Recommendations (110)Test Review (111)Sampling and Handling (111)Test Acceptability Criteria (111)Test Conditions (111)Statistical Methods (111)Concentration-Response Relationships (112)Reference Toxicant Testing (112)Test Variability (113)Cited References (114)Bibliography (119)Appendices (124)A.Distribution, Life Cycle, Taxonomy, and Culture Methods (125)A.1.Ceriodaphnia dubia (125)A.2.Daphnia (D. magna and D.pulex) (140)A.3. Mysids (Mysidopsis bahia and Holmesimysis costata) (159)A.4.Brine Shrimp (Artemia salina) (178)A.5.Fathead Minnow (Pimephales promelas) (185)A.6.Rainbow Trout, Oncorhynchus mykiss and Brook Trout, Salvelinus fontinalis (201)A.7.Sheepshead minnow (Cyprinodon variegatus) (209)A.8.Silversides: Inland Silverside (Mendia beryllina),Atlantic Silverside (M. menidia), and TidewaterSilverside (M. peninsulae) (224)B.Supplemental List of Acute Toxicity Test Species (238)C.Dilutor Systems (240)D.Plans for Mobile Toxicity Test Laboratory (253)D.1.Tandem-Axle Trailer (253)D.2.Fifth Wheel Trailer (256)E.Check Lists and Information Sheets (257)E.1.Toxicity Test Field Equipment List (257)E.2. Information Check List for On-Site Industrial or Municipal Toxicity Test (259)E.3.Daily Events Log (264)E.4.Dilutor Calibration Form (265)E.5.Daily Dilutor Calibration Check (266)vFIGURESNumber Page1.Control (cusum) charts (20)2.Approximate times required to replace water in test chambers in flow-through tests (47)3.Rawson's nomograph for obtaining oxygen saturation values in freshwater atdifferent temperatures at sea level (49)4.Example of data sheet for effluent toxicity tests (69)5.Check list on back of effluent toxicity data sheet (70)6.Flowchart for determination of the LC50 for multi-effluent-concentration acutetoxicity tests (73)7.Plotted data and fitted line for graphical method, using all-or-nothing data (75)8.Example of input for computer program for Trimmed Spearman-Karber Method (80)9.Example of output from computer program for Trimmed Spearman-Karber Method (82)10.Example of input for computer program for Probit Method (84)11.Example of output for computer program for Probit Method (85)12.Flowchart for analysis of single-effluent-concentration test data (86)13.Flowchart for analysis of multi-effluent-concentration test data (87)14.Plot of mean survival proportion data in Table 29 (99)viTABLES Number Pagevii1.Intra-laboratory precision of LC50s from static acute toxicity tests withaquatic organisms using reference toxicants (11)2.Intra- and inter-laboratory precision of acute toxicity tests withDaphnia magna , using a standard effluent (12)3.Inter-laboratory precision of acute toxicity tests with aquatic organisms,using reference toxicants (13)4.Interlaboratory study of acute toxicity test precision, 1990: Summary ofresponses using KCL as the reference toxicant (14)5.National inter-laboratory study of acute toxicity test precision, 1991:Summary of responses using reference toxicants (15)6.National interlaboratory study of acute toxicity test precision, 2000: Precision ofLC50 point estimates for reference toxicant, effluent, and receiving water sample types (16)7.Preparation of synthetic freshwater using reagent grade chemicals (33)8.Preparation of synthetic freshwater using mineral water (34)9.Preparation of synthetic seawater using reagent grade chemicals (34)10.Percent unionized NH 3 in aqueous ammonia solutions: Temperatures between15-26E C and pH's 6.0-8.9 (42)11.Oxygen solubility (mg/L) in water at equilibrium with air at 760 mm Hg (48)12.Summary of test conditions and test acceptability criteria for Ceriodaphnia dubiaacute toxicity tests with effluents and receiving waters (Test Method 2002.0) (51)13.Summary of test conditions and test acceptability criteria for Daphnia pulex andD. magna acute toxicity tests with effluents and receiving waters (Test Method 2021.0) (53)14.Summary of test conditions and test acceptability criteria for fathead minnow,Pimephales promelas , acute toxicity tests with effluents and receiving waters (Test Method 2000.0)..5515.Summary of test conditions and test acceptability criteria for rainbow trout,Oncorhynchus mykiss , and brook trout, Salvelinus fontinalis , acute toxicity testswith effluents and receiving waters (Test Method 2019.0) (57)16.Summary of test conditions and test acceptability criteria for mysid, Mysidopsisbahia , acute toxicity tests with effluents and receiving waters (Test Method 2007.0) (59)17.Summary of test conditions and test acceptability criteria for sheepshead minnow,Cyprinodon variegatus , acute toxicity tests with effluents and receiving waters (Test Method 2004.0).61TABLES(CONTINUED)Number Page18.Summary of test conditions and test acceptability criteria for silverside, Menidiaberyllina, M. menidia, and M. peninsulae, acute toxicity tests with effluents andreceiving waters (Test Method 2006.0) (63)19.Summary of test conditions and test acceptability criteria for west coast mysid,Holmesimysis costata, acute toxicity tests with effluents and receiving waters (65)20.Mortality data (number of dead organisms) from acute toxicity tests used inexamples of LC50 determinations (20 organisms in the control and all testconcentrations) (76)21.Coefficients for the Shapiro Wilk's test (90)22.Quantiles of the Shapiro Wilk's test statistic (92)23.Critical values for Wilcoxon's rank sum test five percent significance level (95)24.Data from an acute single-concentration toxicity test with Ceriodaphnia (95)25.Example of Shapiro Wilk's test: Centered observations (96)26.Example of Shapiro Wilk's test: Ordered observations (96)27.Example of Shapiro Wilk's test: Table of coefficients and differences (97)28.Example of Wilcoxon's rank sum test: Assigning ranks to the control and 100%effluent concentrations (98)29.Fathead minnow survival data (100)30.Centered observations for Shapiro Wilk's example (100)31.Ordered centered observations for the Shapiro Wilk's example (101)32.Coefficients and differences for the Shapiro Wilk's example (102)33.ANOVA table (103)34.ANOVA table for Dunnett's Procedure example (105)35.Calculated t values (106)36.Dunnett's "t" values (107)viiiSECTION 1INTRODUCTION1.1 This manual describes acute toxicity tests for use in the National Pollutant Discharge Elimination System (NPDES) Permits Program to identify effluents and receiving waters containing toxic materials in acutely toxic concentrations. With the exception of the Holmesimysis costata Acute Test (Table 19), the methods included in this manual are referenced in Table IA, 40 CFR Part 136 regulations and, therefore, constitute approved methods for acute toxicity tests. They are also suitable for determining the toxicity of specific compounds contained in discharges. The tests may be conducted in a central laboratory or on-site, by the regulatory agency or the permittee. The Holmesimysis costata Acute Test (Table 19) is specific to Pacific Coast waters and is not listed at 40 CFR Part 136 for nationwide use. This method has been proposed but not yet approved at 40 CFR Part 136.1.2 The data are used for NPDES permits development and to determine compliance with permit toxicity limits. Data can also be used to predict potential acute and chronic toxicity in the receiving water, based on the LC50 and appropriate dilution, application, and persistence factors. The tests are performed as a part of self-monitoring permit requirements, compliance biomonitoring inspections, toxics sampling inspections, and special investigations. Data from acute toxicity tests performed as part of permit requirements are evaluated during compliance evaluation inspections and performance audit inspections.1.3 Modifications of these tests are also used in toxicity reduction evaluations and toxicity identification evaluations to identify the toxic components of an effluent, to aid in the development and implementation of toxicity reduction plans, and to compare and control the effectiveness of various treatment technologies for a given type of industry, irrespective of the receiving water (USEPA, 1988a; USEPA, 1988b; USEPA, 1989a; USEPA, 1989b; USEPA, 1991a).1.4 This methods manual serves as a companion to the short-term chronic toxicity test methods manuals for freshwater and marine organisms (USEPA, 2002a; USEPA, 2002b), the NPDES compliance inspection manual (USEPA, 1988c), and the manual for evaluation of laboratories performing aquatic toxicity tests (USEPA, 1991b). In 2002, EPA revised previous editions of each of the three methods manuals (USEPA, 1993a; USEPA, 1994a; USEPA, 1994b).1.5 Guidance for the implementation of toxicity tests in the NPDES program is provided in the Technical Support Document for Water Quality-based Toxics Control (USEPA, 1991c).1.6 The use of any test species or test conditions other than those described in Tables 12-18 in this manual and referenced in Table 1A, 40 CFR 136.3, shall be considered a major modification to the method and subject to application and approval of alternate test procedures under 40 CFR 136.4 and 40 CFR 136.5.1.7 These methods are restricted to use by, or under the supervision of, analysts experience in the use or conduct of, and interpretation of data from, aquatic toxicity tests. Each analyst must demonstrate the ability to generate acceptable test results with the methods using the procedures described in this methods manual.1.8 This manual was prepared in the established EMSL-Cincinnati format (USEPA, 1983a).1SECTION 2TYPES OF TESTS2.1 The selection of the test type will depend on the NPDES permit requirements, the objectives of the test, the available resources, the requirements of the test organisms, and effluent characteristics such as fluctuations in effluent toxicity.2.2 Effluent acute toxicity is generally measured using a multi-concentration, or definitive test, consisting of a control and a minimum of five effluent concentrations. The tests are designed to provide dose-response information, expressed as the percent effluent concentration that is lethal to 50% of the test organisms (LC50) within the prescribed period of time (24-96 h), or the highest effluent concentration in which survival is not statistically significantly different from the control.2.3 Use of pass/fail tests consisting of a single effluent concentration (e.g., the receiving water concentration or RWC) and a control is not recommended. If the NPDES permit has a whole effluent toxicity limit for acute toxicity at the RWC, it is prudent to use that permit limit as the midpoint of a series of five effluent concentrations. This will ensure that there is sufficient information on the dose-response relationship. For example, the effluent concentrations utilized in a test may be: (1) 100% effluent, (2) (RWC + 100)/2, (3) RWC, (4) RWC/2, and (5) RWC/4. More specifically, if the RWC = 50%, appropriate effluent concentrations may be 100%, 75%, 50%, 25%, and 12.5%.2.4 Receiving (ambient) water toxicity tests commonly employ two treatments, a control and the undiluted receiving water, but may also consist of a series of receiving water dilutions.2.5 A negative result from an acute toxicity test does not preclude the presence of chronic toxicity. Also, because of the potential temporal variability in the toxicity of effluents, a negative test result with a particular sample does not preclude the possibility that samples collected at some other time might exhibit acute (or chronic) toxicity.2.6 The frequency with which acute toxicity tests are conducted under a given NPDES permit is determined by the regulatory agency on the basis of factors such as the variability and degree of toxicity of the waste, production schedules, and process changes.2.7 Tests may be static (static non-renewal or static renewal), or flow-through.2.7.1 STATIC TESTS2.7.1.1 Static non-renewal tests - The test organisms are exposed to the same test solution for the duration of the test.2.7.1.2 Static-renewal tests - The test organisms are exposed to a fresh solution of the same concentration of sample every 24 h or other prescribed interval, either by transferring the test organisms from one test chamber to another, or by replacing all or a portion of solution in the test chambers.2.7.2 FLOW-THROUGH TESTS2.7.2.1 Two types of flow-through tests are in common use: (1) sample is pumped continuously from the sampling point directly to the dilutor system; and (2) grab or composite samples are collected periodically, placed in a tank adjacent to the test laboratory, and pumped continuously from the tank to the dilutor system. The flow-through method employing continuous sampling is the preferred method for on-site tests. Because of the large volume (often 400 L/day) of effluent normally required for flow-through tests, it is generally considered too costly and impractical to conduct these tests off-site at a central laboratory.22.8 Advantages and disadvantages of the types of tests are as follows:2.8.1 STATIC NON-RENEWAL TESTS2.8.1.1 Advantages:1.Simple and inexpensive.2.Very cost effective in determining compliance with permit conditions.3.Limited resources (space, manpower, equipment) required; would permit staff to perform manymore tests in the same amount of time.4.Smaller volume of effluent required than for static renewal or flow-through tests.2.8.1.2 Disadvantages:1.Dissolved oxygen (DO) depletion may result from high chemical oxygen demand (COD),biological oxygen demand (BOD), or metabolic wastes.2.Possible loss of toxicants through volatilization and/or adsorption to the exposure vessels.3.Generally less sensitive than static renewal or flow-through tests, because the toxic substancesmay degrade or be adsorbed, thereby reducing the apparent toxicity. Also, there is less chance ofdetecting slugs of toxic wastes, or other temporal variations in waste properties.2.8.2 STATIC-RENEWAL, ACUTE TOXICITY TESTS2.8.2.1 Advantages:1.Reduced possibility of dissolved oxygen (DO) depletion from high chemical oxygen demand(COD) and/or biological oxygen demand (BOD), or ill effects from metabolic wastes fromorganisms in the test solutions.2.Reduced possibility of loss of toxicants through volatilization and/or adsorption to the exposurevessels.3.Test organisms that rapidly deplete energy reserves are fed when the test solutions are renewed,and are maintained in a healthier state.2.8.2.2 Disadvantages:1.Require greater volume of effluent that non-renewal tests.2.Generally less sensitive than flow-through tests, because the toxic substances may degrade or beadsorbed, thereby reducing the apparent toxicity. Also, there is less chance of detecting slugs oftoxic wastes, or other temporal variations in waste properties.2.8.3 FLOW-THROUGH TESTS2.8.3.1 Advantages:1.Provide a more representative evaluation of the acute toxicity of the source, especially if sample ispumped continuously directly from the source and its toxicity varies with time.2.DO concentrations are more easily maintained in the test chambers.3. A higher loading factor (biomass) may be used.4.The possibility of loss of toxicant due to volatilization, adsorption, degradation, and uptake isreduced.32.8.3.2 Disadvantages:rge volumes of sample and dilution water are required.2.Test equipment is more complex and expensive, and requires more maintenance and attention.3.More space is required to conduct tests.4.Because of the resources required, it would be very difficult to perform multiple or overlappingsequential tests.4SECTION 3HEALTH AND SAFETY3.1 GENERAL PRECAUTIONS3.1.1 Development and maintenance of an effective health and safety program in the laboratory requires an ongoing commitment by laboratory management, and includes (1) the appointment of a laboratory health and safety officer with the responsibility and authority to develop and maintain a safety program, (2) the preparation of a formal, written, health and safety plan, which is provided to each laboratory staff member, (3) an ongoing training program on laboratory safety, and (4) regularly scheduled, documented, safety inspections.3.1.2 Collection and use of effluents in toxicity tests may involve significant risks to personal safety and health. Personnel collecting effluent samples and conducting toxicity tests should take all safety precautions necessary for the prevention of bodily injury and illness which might result from ingestion or invasion of infectious agents, inhalation or absorption of corrosive or toxic substances through skin contact, and asphyxiation due to lack of oxygen or presence of noxious gases.3.1.3 Prior to sample collection and laboratory work, personnel must determine that all required safety equipment and materials have been obtained and are in good condition.3.1.4 Guidelines for the handling and disposal of hazardous materials must be strictly followed.3.2 SAFETY EQUIPMENT3.2.1 PERSONAL SAFETY GEAR3.2.1.1 Personnel must use safety equipment, as required, such as rubber aprons, laboratory coats, respirators, gloves, safety glasses, hard hats, and safety shoes.3.2.2 LABORATORY SAFETY EQUIPMENT3.2.2.1 Each laboratory (including mobile laboratories) must be provided with safety equipment such as first aid kits, fire extinguishers, fire blankets, emergency showers, and eye fountains.3.2.2.2 Mobile laboratories should be equipped with a telephone to enable personnel to summon help in case of emergency.3.3 GENERAL LABORATORY AND FIELD OPERATIONS3.3.1 Guidance in Material Safety Data Sheets should be followed for reagents and other chemicals purchased from supply houses. Incompatible materials should not be stored together.3.3.2 Work with effluents must be performed in compliance with accepted rules pertaining to the handling of hazardous materials (see Safety Manuals, Subsection 3.5). Personnel collecting samples and performing toxicity tests should not work alone.3.3.3 Because the chemical composition of effluents is usually only poorly known, they must be considered as potential health hazards, and exposure to them should be minimized. Fume and canopy hoods over the test areas must be used whenever necessary.3.3.4 It is advisable to cleanse exposed parts of the body immediately after collecting effluent samples.53.3.5 All containers must be adequately labeled to indicate their contents.3.3.6 Strong acids and volatile organic solvents employed in glassware cleaning must be used in a fume hood or under an exhaust canopy over the work area.3.3.7 Good housekeeping contributes to safety and reliable results.3.3.8 Electrical equipment or extension cords not bearing the approval of Underwriter Laboratories must not be used. Ground-fault interrupters must be installed in all "wet" laboratories where electrical equipment is used.3.3.9 Mobile laboratories must be properly grounded to protect against electrical shock.3.4 DISEASE PREVENTION3.4.1 Personnel handling samples which are known or suspected to contain human wastes should be immunized against hepatitis B, tetanus, typhoid fever, and polio.3.5 SAFETY MANUALS3.5.1 For further guidance on safe practices when collecting effluent samples and conducting toxicity tests, check with the permittee and consult general industrial safety manuals, including USEPA (1986) and Walters and Jameson (1984).3.6 WASTE DISPOSAL3.6.1 Wastes generated during toxicity testing must be properly handled and disposed of in an appropriate manner. Each testing facility will have its own waste disposal requirements based on local, state, and Federal rules and regulations. It is extremely important that these rules and regulations be known, understood, and complied with by all persons responsible for, or otherwise involved in, performing testing activities. Local fire officials should be notified of any potentially hazardous conditions.6SECTION 4QUALITY ASSURANCE4.1 INTRODUCTION4.1.1 Development and maintenance of a toxicity test laboratory quality assurance (QA) program requires an ongoing commitment by laboratory management, and includes the following: (1) appointment of a laboratory quality assurance officer with the responsibility and authority to develop and maintain a QA program;(2) preparation of a quality assurance plan with data quality objectives; (3) preparation of written descriptions of laboratory standard operating procedures (SOP's) for test organism culturing, toxicity testing, instrument calibration, sample chain-of-custody, laboratory sample tracking system, etc.; and (4) provision of adequate, qualified technical staff and suitable space and equipment to assure reliable data.4.1.2 QA practices within an aquatic toxicology laboratory must address all activities that affect the quality of the final effluent toxicity data, such as: (1) effluent sampling and handling; (2) the source and condition of the test organisms; (3) condition and operation of equipment; (4) test conditions; (5) instrument calibration; (6) replication;(7) use of reference toxicants; (8) record keeping; and (9) data evaluation.4.1.3 Quality control practices, on the other hand, consist of the more focused, routine, day-to-day activities carried out within the scope of the overall QA program. For more detailed discussion of quality assurance, and general guidance on good laboratory practices related to toxicity testing, see: FDA, 1978; USEPA, 1975; USEPA, 1979a; USEPA, 1980a; USEPA, 1980b; USEPA, 1991b; DeWoskin, 1984; and Taylor, 1987.4.1.4 Guidance for the evaluation of laboratories performing toxicity tests and laboratory evaluation criteria may be found in USEPA 1991b.4.2 FACILITIES, EQUIPMENT, AND TEST CHAMBERS4.2.1 Separate test organism culturing and toxicity testing areas should be provided to avoid possible loss of cultures due to cross-contamination. Ventilation systems should be designed and operated to prevent recirculation or leakage of air from chemical analysis laboratories or sample storage and preparation areas into organism culturing or toxicity testing areas, and from toxicity test laboratories and sample preparation areas into culture rooms.4.2.2 Laboratory and toxicity test temperature control equipment must be adequate to maintain recommended test water temperatures. Recommended materials must be used in the fabrication of the test equipment which comes in contact with the effluent (see Section 5, Facilities and Equipment).4.3 TEST ORGANISMS4.3.1 The test organisms used in the procedures described in this manual are listed in Section 6, Test Organisms. The organisms should appear healthy, behave normally, feed well, and have low mortality in cultures, during holding, and in test controls. Test organisms should be positively identified to species.4.4 LABORATORY WATER USED FOR CULTURING AND TEST DILUTION WATER4.4.1 The quality of water used for test organism culturing and for dilution water used in toxicity tests is extremely important. Water for these two uses should come from the same source. The dilution water used in effluent toxicity tests will depend in part on the objectives of the study and logistical constraints, as discussed in detail in Section 7, Dilution Water. The dilution water used for internal quality assurance tests with organisms, food, and reference toxicants should be the water routinely used with success in the laboratory. Types of water are discussed in Section7。

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